Utilization Management Nurse Consultant

CVS Health•Work At Home-Pennsylvania, PA

16d•$29 - $62•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Afternoon/Evening Shifts Available | 24/7 Operations Are you an experienced RN looking to bring your clinical expertise to a fast-paced, collaborative Utilization Management team? Join us in helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.

Requirements

Active, unrestricted RN license in your state of residence
2+ years of adult acute care and/or critical care nursing experience
Strong clinical assessment and decision-making skills
Ability to navigate multiple computer systems and manage competing priorities
Excellent verbal and written communication skills
Associate Degree in Nursing required
Willing to work weekends, holidays, and evening shifts.

Nice To Haves

2+ years of Med-Surg or specialty nursing experience
Managed Care experience, particularly Utilization Management
Reside in the Eastern Time Zone
BSN preferred

Responsibilities

Review clinical information and apply evidence-based criteria to support coverage determinations
Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
Collaborate with providers and care teams to facilitate appropriate treatment plans
Identify opportunities to improve quality, efficiency, and healthcare utilization
Connect members to additional programs and services as appropriate
Serve as a clinical resource for internal and external stakeholders